Improving Abortion Access, Bringing Health Care Home


This piece is part of the Echoing Ida project, cross-posted with permission from Strong Families.

Each time I take a road trip down California’s magnificent highways, I can’t help but think of the dozens of people who have stayed in my home while in the Bay Area for an abortion. I pass the road signs indicating the off-ramps for Modesto, Los Banos, and Humboldt thinking fondly of the friends I made, but sad about how far they had to travel for their abortions.

For over a year, I have served as a Practical Support Volunteer for ACCESS Women’s Health Justice; I house, prepare dinners for, and give rides to people staying in the Bay Area for an abortion procedure. They come by bus, train, and sometimes car, traveling for four-to-five hours at a time, because access to abortion procedures near their hometown is lacking. They come because they didn’t realize they were pregnant until it was past the gestational limit and the clinic nearest to them couldn’t perform the abortion. They come because the time they took to thoughtfully consider all their pregnancy options meant their procedure would cost more.

They come because the clinic closest to them shares an abortion provider with several other clinics and it could be a while before they can get an appointment. They come because while they were working and saving money to pay for an abortion, they crossed a gestational threshold and now must find more money for a more expensive procedure. They scrimp and save to take off more time from work to travel for what was a one-day, but is now a two-day procedure; get someone to cover a work shift; ask someone to watch their children; and, if they’re able to, find a supportive friend or partner to join them as they travel across the state to a city they’ve never been to … all for health care.

When my friends stay in my home, we sit on the couch and talk over dinner. We talk about how far they’ve traveled, their lives back home, their beautiful children, and what the next couple of days might look like. They often ask me why they couldn’t have an abortion in their own towns, where their support people could accompany them and hold their hands, where they would be able to go home the same day and tuck their children in at night after the procedure. Until now, I didn’t have an answer for them. But now that answer is waiting for a vote and a signature. The answer is California’s Early Access to Abortion Bill.

Earlier this year, assembly member Toni Atkins (D-San Diego) introduced AB 154, a bill that would increase the number of abortion providers, by allowing trained certified nurse midwives (CNM), nurse practitioners (NP), and physician assistants (PA) to provide early abortion care. This means that more people, especially in rural areas, will be able to have access to comprehensive abortion care earlier in their pregnancies, which would help reduce the rate of complications, bring down the cost for the procedure, and allow a patient to get the care they need closer to home. Many people don’t know that almost half of the counties in California don’t have an accessible abortion provider, and 22 percent of counties don’t have a provider at all. This creates an additional hardship on those in rural areas who have to travel further for their procedures.

Recently, the University of California, San Francisco’s Bixby Center for Global Reproductive Health conducted a multi-yearlong study in which they trained and evaluated CNMs, NPs, and PAs as they performed first trimester abortions alongside the doctors performing the same procedure—the outcomes were the same. With 92 percent of abortions in the United States occurring within the first trimester, the bill would reduce barriers and increase access for the majority of people seeking abortion care. AB 154 is legislation that supports the needs of our communities.

In the United States, 6 in 10 people having an abortion are already parenting a child, while 3 in 10 have two or more children. In the evening, I often hear clients making phone calls, putting their children to bed, telling them how much they love them. “Don’t worry,” they say, “I’ll be home to put you to bed tomorrow.” Wouldn’t it be nice if they could get the care that they need and be home in time to kiss their children goodnight? Instead of having to leave their families and travel five hours for a simple medical procedure, imagine if care were provided in their own hometown. I was fortunate—my abortion provider was a 15-minute ride from my house. I felt safe knowing that I wasn’t far from my home and I would be able to rest in my bed with my family nearby soon after the procedure.

The Early Access to Abortion bill is model legislation that will put patients and families first and contribute to healthy communities.

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  • fiona64

    The anti-choice labor under the impression that women who seek abortions have no children (they labor under that impression about the pro-choice as well …). The statistics in this article in re:parenting are important to combat that perception.

    Thank you for all you do as a practical support volunteer, and for telling the truth: denying access to a full range of health services means that they may as well be illegal. Women need support and assistance to obtain care.

  • Arachne646

    This is so important, and needs to happen in so many more places than just California. Your explanations of why abortions are delayed until later in a pregnancy, when they could have been done more simply and inexpensively if a provider nearby could have done the procedure without the patient having to arrange to travel and stay near a large clinic in a central city for a later abortion, was really useful.

  • singingsoprano

    I completely disagree. This is a surgical procedure that DOES have risk. According to the testimony of Dr. Vansen Wong (who, incidentally was in charge of abortion services, so not objecting on moral grounds ) “The risk of complications from abortion doubles in the hands of non-physicians. When non-physicians performed abortions there were more incomplete or unsuccessful abortions that not only required a repeat procedure but exposed women to risks of serious infection or bleeding. Excessive bleeding was also more common which can lead to profound weakness and a lengthy recovery. The most frightening complication was a uterine perforation, when the suction cannula punctured the uterus. This was a potentially fatal complication that easily could have resulted in life threatening injury to the intestines or major blood vessels. “… the complication rate of abortions done by non-physicians [will] No doubt [be] higher than the complication rate of this study. Any CNM, NP or PA will be able to perform the procedure after completing a “course,” the requirements of which have yet to be determined” I am sympathetic that women are finding themselves in difficult situations due to unplanned pregnancy, but I think THAT is the side we should all be working on–to make sustaining life a more tenable choice–not to make ending pregnancy an easier proposition, and certainly not at the expense of safety.

    • Arekushieru

      I think you’re confused. Continuing a pregnancy is by FAR more dangerous than having an abortion. And those who tend to make ending a pregnancy a more DIFFICULT proposition often tend to make pregnancy a more difficult propositionl, as well. Iow, those whom you lament for not doing more to make pregnancy easier, ARE the ones trying to improve access to BOTH choices. And, why shouldn’t ending a pregnancy be an easier proposition?

    • ActuallyReadTheArticle

      If you actually look at the results of the study, it shows that there was no statistical difference between the doctors and CNMs, NPs, or PAs (not the “double” you claim) – and the rate of error was below the national average. First trimesters are one of the safest procedures known to the medical industry. Also, the professionals treating patients already know “abortion care” as they are taught it and practice it as “miscarriage management”, so the training is extra, not something new. Here’s the link to the study if you’d like to read it: http://www.ansirh.org/_documents/library/posters/2010-6Battistelli-HWPP.pdf There are also a ton of links in the article that you should read about the law and the study.